Sinusitis: Symptoms, Diagnosis, Treatment

Sinus Attack!

Pain in the forehead or between the eyes? Upper teeth ache? Face feeling full, nose stuffy and congested? You may have a common complaint that sends many people to a doctor's office: sinus trouble.

What Are Sinuses?

What Are Sinuses?

They’re air spaces in your skull lined with mucous membranes. Most people have four sets of nasal sinuses:

• Two in the forehead above the eyes
• One inside each cheekbone (dark triangles seen in this image)
• A group of them, called the ethmoid sinuses, behind the bridge of the nose
• Another group behind the nose and underneath the brain called the sphenoid sinuses

Sinuses are like fingerprints: Everybody's are different.  Some people have no frontal sinuses or just one.

What Is Sinusitis?

It’s inflammation in your sinuses. Tiny, hair-like structures called cilia (magnified here) move mucus across sinus membranes and toward an exit. All of your sinus cavities connect to your nose to allow a free exchange of air and mucus. Infections or allergies make sinus tissues inflamed, red, and swollen.

Just a Cold … at First

Sinusitis usually starts with inflammation triggered by a cold, allergy attack, or irritant. But it may not end there. Colds, allergies, and irritants make sinus tissues swell.

How It Feels

Most people have a stuffy nose and pain or pressure in several areas around the face or teeth. There's usually a nasal discharge that may be yellow, green, or clear. You may also have fatigue, trouble with sense of smell or taste, cough, sore throat, bad breath, headache, pain when you bend forward, and fever.

When It Won't Go Away

Inflammation of the sinuses that lasts for more than 3 months is chronic sinusitis. Bacteria can make their home in blocked sinuses, but they aren’t the only cause. Anatomy, allergies, polyps, immune system problems, and dental diseases may also be to blame.

Nasal Polyps

If your sinuses remain inflamed, sinus membranes can thicken and swell. The swelling may be enough to cause grape-like masses called polyps (shown here). They can jut out from the sinus into the nasal passage and block your nasal airway.

Nasal Decongestants

These sprays open swollen nasal passages and allow your sinuses to drain. But you should use these drugs only for a few days. After that, there's a kickback effect, making your nasal passages swell shut again. Nasal steroid sprays, or saline sprays or washes, may be other options. If symptoms don’t stop, see your doctor.

Do You Need Antibiotics?

The common cold is a viral infection. Colds can lead to sinusitis symptoms, but these usually clear by themselves. Antibiotics don’t treat viruses, so they won't help the sinus symptoms of a cold. Your cold should be over in a week or two. Usually, cold-related sinusitis goes away then, too.

Treating Allergy-Related Sinusitis

Have you tried irrigation with saline solution, either with a neti pot or squeeze bottle? Nasal steroid sprays might help, too, if your sinus symptoms are due to allergies. Antihistamines could also come in handy, especially if you’re sneezing and have a runny nose.

When to See the Doctor

Yellow or green mucus can mean a bacterial infection. Even then, it usually clears up in 7 to 14 days without antibiotics. But if you keep feeling worse, your symptoms last and are severe, or if you get a fever, it's time to see a doctor.

Will You Need Sinus Surgery?

An operation called FESS (functional endoscopic sinus surgery) can bring some relief, if nothing else works. But start with the simplest solution: Avoid things that irritate your sinuses, and then work with your doctor to see if medicines help. Surgery is the last resort.

Rare Complications

Only a layer of bone separates your sinuses from your brain. It’s not likely, but if a sinus infection passes through the bone, it can infect the lining of the brain or the brain itself. It’s also uncommon, but a sinus infection could spread into the eye socket, causing an infection that could cause blindness. Less severe complications include asthma attacks and loss of smell or taste, which are usually temporary.

Can You Prevent Sinusitis?

Unfortunately, no. But you can do these three things that help:

• Keep your sinuses moist. Use saline sprays, nasal lubricant sprays, or nasal irrigation often.
• Avoid very dry indoor environments.
• Avoid exposure to irritants, such as cigarette smoke or strong chemical odors.